Provider Demographics
NPI:1164494936
Name:MONTE MAR HEALTH CORPORATION
Entity Type:Organization
Organization Name:MONTE MAR HEALTH CORPORATION
Other - Org Name:MONTE MAR MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GILBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:MED
Authorized Official - Phone:787-270-3999
Mailing Address - Street 1:HC 83 BOX 6207
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-9706
Mailing Address - Country:US
Mailing Address - Phone:787-270-3999
Mailing Address - Fax:
Practice Address - Street 1:CARR 694 KM. 1.1
Practice Address - Street 2:BARRIO ESPINOSA, SECTOR MONTERREY
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692-9706
Practice Address - Country:US
Practice Address - Phone:787-270-3999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-06
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5973300001Medicare NSC